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Lorraine

Recent C & P For Ao Diabetes Type 2

Question

After my Vet had filed a claim AO/IHD, he was diagnosed with diabetes type 2. We were new to all of the stuff with dealing with the VA, so just let that claim go ahead in order not to muddy the waters and figured we'd deal with that down the road at some point. When they awarded him 60% for IHD, VA noted his diagnosis of diabetes type 2 in subsequent medical records they requested and advised him to gather the appropriate records and file for diabetes type 2. Couldn't have been more surprised to have them suggest that!

Anyway, we took the info to his VSO and he filed the paperwork for us and he rather quickly got an appt. for a C & P. The doc was an external examiner(a D.O.), but not with QTC. He was very personable, did a thorough exam, followed the protocol per the exam sheet, focused a lot on peripheral artery exam. Ended the interview by thanking my Vet for his service. Several weeks later, my Vet got notified from QTC that he was scheduled for another echocardiogram - same clinic they'd sent him to a little over a year ago for his IHD claim. I was surprised by that with a claim for diabetes type 2, but from what I've read, if there is heart disease then they follow the work sheet for that. Haven't heard anything yet - has been about six weeks, IRIS says the claim is in the decision phase(uh-huh).

Wondering if anybody else has had an echo as part of the C & P for diabetes type 2. Being on the paranoid side when it comes to dealing with the VA, I'm worried that the 2nd echo done by a different examiner will come up with a different percentage on the ejection fraction (he was rated at just 50% and those of you that have been thru this, know that's the pivotal number for a 60% rating). So, I'm antsy again.

Lorraine

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3 answers to this question

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AO Nehmer court rulings are likely at the heart of the VA's actions. They are required to look at any and all AO presumptive conditions, as well as any others in the records that might be associated with military service. The VA put out a "Fast letter" instruction to the RO's concerning what had to be done. An IHD diagnosis can be confirmed by testing such as you mentioned. An echo cardiogram can be done in different ways. http://www.heartsite...cardiogram.html is a better description than I might give. It is interesting that they are calling for a second exam relating to IHD after awarding the claim.

Combined with a chemical stress test, it's quite definitive, and reasonably safe when conducted by a cardiologist. The "Gold Standard" is actually a cardiac cath. (I've had both types of tests in the fairy recent past)

Another similar test involves radioactive dye, etc. A chemical stress test increases the heart rate and strength of the pumping actions. When IHD is present, the heart starts to show visible symptoms that are rather obvious. A cardiologist can easily define the amount of "efficiency", and any damaged areas. This can be translated to the scheme the VA uses to determine compensation. As an example, 30% or less LVEF translates to a VA scheduler rating of 100%. The radioactive dye can also show blockages and restrictions in the various arteries. With a significant case of IHD, a standard electrocardiogram will usually have abnormalities. These also point to damaged areas of the heart. DMII and IHD seem to be part of a not well defined set of problems referred to as metabolic disorder. IHD generally means that there are blockages, and they may need to be dealt with. DMII can increase the risks of blockages forming and existing ones becoming more severe.

Actually, the VA screwed up in that medical records showing DMII should have resulted in the VA automatically starting the claim process for it without further action from you, other than supplying any additional records needed to define the level of DMII. DMII is usually rated at 10 to 20%. The "Fast Letter" I mentioned instructs the RO to do a more comprehensive review of medical records than they have routinely done in the past. Get the claim out the door was more important than a complete development.

After my Vet had filed a claim AO/IHD, he was diagnosed with diabetes type 2. We were new to all of the stuff with dealing with the VA, so just let that claim go ahead in order not to muddy the waters and figured we'd deal with that down the road at some point. When they awarded him 60% for IHD, VA noted his diagnosis of diabetes type 2 in subsequent medical records they requested and advised him to gather the appropriate records and file for diabetes type 2. Couldn't have been more surprised to have them suggest that!

Anyway, we took the info to his VSO and he filed the paperwork for us and he rather quickly got an appt. for a C & P. The doc was an external examiner(a D.O.), but not with QTC. He was very personable, did a thorough exam, followed the protocol per the exam sheet, focused a lot on peripheral artery exam. Ended the interview by thanking my Vet for his service. Several weeks later, my Vet got notified from QTC that he was scheduled for another echo cardiogram - same clinic they'd sent him to a little over a year ago for his IHD claim. I was surprised by that with a claim for diabetes type 2, but from what I've read, if there is heart disease then they follow the work sheet for that. Haven't heard anything yet - has been about six weeks, IRIS says the claim is in the decision phase(uh-huh).

Wondering if anybody else has had an echo as part of the C & P for diabetes type 2. Being on the paranoid side when it comes to dealing with the VA, I'm worried that the 2nd echo done by a different examiner will come up with a different percentage on the ejection fraction (he was rated at just 50% and those of you that have been thru this, know that's the pivotal number for a 60% rating). So, I'm antsy again.

Lorraine

Edited by Chuck75

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Always Excellent replys from Chuck! That one is right on the button.

What gets me is how VA could deny IHD as due to DMII in the past yet the new AO regs can overcome that.

A veteran could easily have two bases for SC -one under the new IHD regs and one as IHD secondary to the DMII and try for the most favorable EED.

I think many vets have DMII long before the VA even diagnoses it and it could have already begun some IHD damage.

Lorraine asked:

"Wondering if anybody else has had an echo as part of the C & P for diabetes type 2."

I sent my husband's ECHO to VA for the DMII claim I had last year.Also sent the MRI of his brain as he had suffered multiple strokes all secondary to the DMII.Echos are important as CHuck said for proper ratings.

"focused a lot on peripheral artery exam" Maybe this could be cause for another ECHO?

Although the IHD regs do not rule in a PAD diagnosis as establishing a IHD diagnosis (PAD peripheral arterial disease) the PAD can be claimed as secondary to the IHD,once that diagnosis is established.

My IMO doctor quoted Braunwald (a Top notch cardio text)( Braunwald - who collaborated with Harrison's Principles- the standard for IHD claims that VA is using)to associate my husband's PAD with his AO induced DMII and IHD.

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Thank you to both Berta and Chuck for their always informative responses. Your vast amount of knowledge is incredible.

My Vet had three cardiac arrests at age 39, followed by four by-passes, then six years ago had a "re-do" and another five by-passes. I doubt they'll request any further cardiac work up than the echo--determined it was too risky to even do a stress test for the IHD exam. He's had angiograms, and nuclear stress tests previously in the private sector and they have those records.

But, like I said --I'm a bit paranoid about the VA and worry about his rating being reduced. I know there is always that chance. But, from the posts I've been reading over the last six moths, it appears that the climate within the VA under Shinseki is more favorable to Vets than previously. Hope I'm right.

Lorraine

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